Objective: We aimed to evaluate the cost effectiveness of different prenatal test strategies in Korean pregnant women after the implementation of noninvasive prenatal testing (NIPT). Methods: Singleton (< 24 weeks of gestation) pregnant women who are candidates for the identification of fetal aneuploidy were enrolled in 12 different healthcare institutions between June 2016 and October 2018. The cost effectiveness of different prenatal test strategies was analyzed in all pregnant women and elderly pregnant women over 35 years. We designed a decision tree model for each of the cases with maternal serum screening test (MSS), NIPT, invasive diagnostic test (IT), and no test group. As a parameter of the decision tree model, probability by prenatal test results, probability by pregnancy outcomes, cost, and utility by pregnancy outcomes were used. Contingent valuation method was used for maternal utility (QALY) according to the pregnancy outcomes and measured obstetrician health care providers as proxy. Cost utility was reported using the incremental cost utility ratio (ICUR). To investigate the uncertainty, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. Results: A total of 7,547 pregnant women were enrolled during the study. As a result of analyzing the cost effectiveness for all pregnant women, NIPT was superior to IT and cost effective than no test (ICUR = 5,102,428 won / QALY), but MSS was superior to NIPT when compared with MSS. As a result of analysis for elderly pregnant women, NIPT was superior to IT and cost effective than no test (ICUR=4,885,045 won/QALY) but was not cost effective compared to the current cost-effectiveness baseline of 25 to 30 million won compared to MSS (ICUR=46,181,842won/QALY). Conclusion: NIPT was not more cost effective than MSS in all pregnant women and elderly pregnant women. However, NIPT is more accurate than MSS and has clinical advantages such as the number of IT decrease. In the future, the cost effectiveness of NIPT will be recognized in the elderly pregnant women if the economic baseline of Korea is more than 46 million won.